Saturday, February 28, 2015

The Numbers if Supreme Court Rules Against Federal Subsidies

None of us really understands what’s going on with all those numbers.

David Stockman (born 1946), Director of Management and Budget under President Reagan

Just give me the numbers. I will understand.


Here are the numbers for you out there seeking to understand what happens if the Supreme Court renders an adverse opinion on subsidies in federal health exchanges.

13 states operating their own exchanges would be unaffected.

87% enrolled in 37 states with federal health exchanges would be affected,

9.3 million could lose $28.8 billion in subsidies.

150 million who pay taxes would gain from loss.

Number of uninsured could rise by 8.2 million.

Premiums could rise by 47% with a 70% drop in enrollments.

Supreme Court decision would take effect in 25 days.

Congress could make decision go away by striking 1 phrase out of current health law “established by the state.”

Neither of the 2 sides, Democratic or Republican, has yet articulated a comprehensive alternative.

If the 2 sides do articulate an alternative , if I may quote Dr. Seuss, “You will see something new. Two things. And I call them Thing One and Thing Two.”

Thursday, February 26, 2015

Apocalypse, Armageddon, or Just Plain Politics

Wild, dark times are rumbling towards us, and the prophet who wishes to write a new apocalypse will have to invent new beasts.

Heinrich Heine (1797-1846), German romantic poet

Obama Care supporters and critics alike are projecting an image of Apocalypse, of Armageddon, the final battle between Good and Evil, with Evil winning, if the Supreme Court rules against federal exchange subsidies for 6 million people.

New beasts will roam upon us. Chaos will ensue. Insurers will descend into bankruptcy. Premiums will soar. Hospitals will close. Six million subsidized citizens will die in the streets. Chemotherapy will be turned off for 12,000 people. Dialysis wards for 10,000 will go dark.

If you doubt this scenario, read today’s news, (Joshua Green, “Is Washington Ready for the Death of ObamaCare,” Bloomberg Politics), or Senator Ben Sasse (R.Nebraska), “ A First Step on the Way Out of ObamaCare,” Wall Street Journal).

To Democrats, such scaremongering is understandable. Death of ObamaCare at the hands of the Court is so unthinkable, they do not mention an alternative or whisper that defeat is possible.

Republicans fear they will get what they wished for, the collapse of ObamaCare, and they will take the political blame for its untimely demise with cataclysmic results in the 2016 elections.

In their heart of hearts, both sides seem to be anticipating defeat or even death of ObamaCare . The Court itself is mum on the subject, for it has yet to read all the amicus briefs or to hear the oral arguments for or against.

It is clear if federal subsidies go down, for the sake of humanity, there will have to be a transition period out of ObamaCare and in the interim those previously subsidized will have to be subsidized . Senator Sasse of Nebraska recommends an 18 month period of transition until Democrats and Republicans get their act together, compromise, and craft an acceptable alternative plan that combines governmental and market-based principles.

The plan will not be one-size-fits-all plan, but various sizes-fitting most of the people most of the time-– depending on their need for government assistance - and their desire for freedom and choice.

Wednesday, February 25, 2015

Who Is Teetering and Who is Tottering? ObamaCare or the Supreme Court?

Teeter Tottering, in Washington, D.C. lingo, is perceived as swaying, seesawing, tipping up and down, and wobbling under political pressure. For me, teeter tottering evokes the image of children on the ends of a teeter totter, shifting their weights and positions to raise or lower themselves.

I thought of teetering and tottering when I read the CNN Report headline, “ObamaCare Is Once Again Teetering Before the Supreme Court.”

Its author, Ariane de Vogue, CNN’s Supreme Court Reporter, begins,

“The Obama administration most significant legislative achievement is now, once again teetering before the Supreme Court.”

The health law is presumed to be teetering because ObamaCare itself teetering. It is still looked upon with disapproval by the majority of Americans, and a Republican Congress has voted to repeal by the 30th time. It is also assumed to be tottering by the Justices, who are often split in 5 to 4 decisions, with Justice Roberts and Kennedy being the most common swingers. The Justices are caught between a rock, the phrase “established by the state, “ indicating subsidies are only available in health exchanges established by states, and a hard place, that 6 to 7 million citizens subsidized in federal exchanges might have to pay back or lose their subsidies if the health law teeter totter goes down, while the conservative and Republican side of the teeter totter goes up.

ObamaCare critics say the word of the law is the law and “opens the door to hundreds of millions of additional spending,” roughly $30 billion a year by my count.

ObamaCare supporter retort writers of the health law always intended to make subsidies available to all who qualified. Solicitor General Donald Vericelli, Jr. will subsidy spending for all was “abundantly clear” what Congress, i.e. Democrats, always mean and that a negative ruling would result in a “death spiral,” not only for the insurance industry, but for hospitals and patients without insurance as well. Besides, he may assert, the four plaintiffs who brought the case before the court do not have “standing” because they were not hurt by the health law.

I did not learn anything from Adriane de Voge’s article that I did not know already. She correctly states that there are tremendous stakes riding on the Supreme Court outcome, including the fates of 6 million who will become uninsured and the President’s legacy. Nor do I whole buy into the teeter tottering argument. We have now had 5 years of ObamaCare, and its benefits and consequences are well known. Neither its advocates or supporters are teetering or tottering. They are not children on a teeter totter, nor are the Supreme Court Justices, who are mature attorneys unlikely to be easily swayed by facile arguments from either side of the political aisle.

Tuesday, February 24, 2015

Six Simple Minded Supreme Court Solutions

For every complex problem, there is a answer that is clear, simple, and wrong.

Henry Mencken (1880-1956), political commentator known as the Sage of Baltimore

On March 4 the Supreme Court will hear arguments in King v.Burwell with a decision expected in late June.

Observers has suggested and are lobbying for six solutions to the complex health care law.

One, no change in law whatsoever. This appeals to be the Obama administration position. It has put forth no alternative.

Two, a simple change in the text of the law, namely, delete “established by the state” and make it clear the law applies to both state and federal exchanges.

Three, keep good provisions in law. Repeal and replace. Have states distribute “health checks” via state governments for those who received subsidies. Return control of exchanges and Medicaid to states.

Four, go with Republican alternative plan, which ends mandates and exchanges, retains some aspects of law, and stresses market-based competition.

Five, exercise the “freedom option.” If you like ObamaCare and its subsidies, keep them. If you don’t, you are free to dump ObamaCare and to buy the insurance you need. (Phil Gramm, “A Simple Cure for ObamaCare: Freedom," WSJ, February 23, 2015).

Six, none of the above. Go with Medicare or Medicaid for all.

None of these simple options will take place in their pure form. ObamaCare , with all its virtues and faults, is too complex, Its vested interests are too entrenched, too partisan, and too fixed in their ideologies. But one can dream that somewhere out there looms a clear, simple solution in that never-never land between private freedom and choice and federal control and coercion.
American Court of Opinion: Liberal Amicus Briefs

Amicus briefs educate the court on points of law that are in doubt or organize information to raise awareness that the court might not otherwise be aware of on social issues.

Definition, Amicus Brief

As is my custom, I read the New York Times Sunday Week in to see what the left is thinking.

Among the pickings these week arel

A puff piece on 81 year old Ruth Bader Ginsburg (Gail Collins, “The Unsinkable R.B.G.: The Nonretiring Justice Ginsberg”) , who is “planning to be on the bench when the Court decides mammoth issues like the future of the Affordable Care Act and the national right of gay couples to marry.”

On page 14 of the front section (Robert Pear, “Flood of Briefs on Health Law’s Subsidies”) on why America’s hospitals, insurance industry, and other health industry stakeholders are deluging courts with briefs to convince them to maintain federal subsidies on the health care exchanges.

An article in in the Week in Review section by Steven Rattner on why ObamaCare has improved the quality of health care and largely delivered on its promises. *For Tens of Millions , ObamaCare Is Working”.)

Among the facts on ObamaCare’s achievements, according to Rattner, are these.

A drop in the number of uninsured from 42 million by 13.4 million to 28.9 million.

A drop in “inferior plans,” i.e. those not meeting ObamaCare’s 10 essential benefits standards.

New benefits for 31 million Americans who signed up for health exchanges, became recipients in expanded Medicaid plans, or participated in plans in which they were previously denied coverage for pre-existing conditions or in which young adults under 26 could nto participate in their parents’ health plans.

Rattner concludes:

“The program still faces challenges – notably a Supreme Court decision in June that has the potential to undermine the program in many states. There are disappointments , too: millions of Americans faced higher premiums after being forced off substandard plans.”

Rattner might have added, for tens of millions ObamaCare is not working too: for American small businessmen who must drop full-time and part-time employers from coverage, for the young and healthy forced to pay higher premiums for older and sicker Americans are pay penalties they can ill afford, for the American middle class forced to pay higher premiums and deductible and to switch from their current health plans and doctors with which they are satisfied, for American physicians who can no longer afford to stay in private independent practice because of mandated EHRs, cuts in reimbursement , and regulations, and American taxpayers who must pay $500 billion so far and an estimated $1,5 to $2 trillion over the next decade.

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Vice Versa

It’s six of one, half dozen of the other.

It’s the reverse, one way or another,

With the health law, it’s your freedom and choice,

Versus coercion and a more compassionate voice.

It ‘s a left of center president.

In a nation towards the center bent.

It ‘s the urban, bicoastal elite.

Versus folks who move to a common beat.

It ‘s domestic homeland security,

Versus immigrant’s amnesty surety.

However you put it, one way or another,

As seen by Big Brother or Blood Brother,

One person’s passionate reason,

Is another person’s personal lesion.